Pope counsels Catholics on end-of-life decisions

In a recent message on end-of-life care, Pope Francis said that it is permissible and moral for a patient to decide, in dialogue with medical professionals, that a proposed or ongoing course of treatment that might extend their life is nevertheless overzealous and disproportionate. The patient is not required by their Catholic faith to use every tool and treatment available, he said.

The pope cited a similar position on end-of-life treatment espoused by Pope Pius XII about 60 years ago. Since then, advances in therapies, surgeries, technologies and other medical interventions have made it possible "to extend lives by ways that were inconceivable in the past," Pope Francis wrote. "Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person."

Cardinal Peter Kodwo Appiah Turkson, prefect for the Vatican Dicastery for Promoting Integral Human Development, read the pope's message Nov. 16 at the World Medical Association European Region Meeting on End-of-Life Questions. The two-day meeting at the Vatican brought together European medical professionals, legal authorities, experts in palliative care and medical ethics, theological scholars and philosophers. It was co-hosted by the Pontifical Academy for Life, the World Medical Association and the German Medical Association.

In a message that underscored concepts included in the catechism of the Catholic Church, the pope wrote that foregoing treatment can in certain circumstances be a way of acknowledging the limits of human mortality and accepting the inevitability of death. From an ethical standpoint, avoiding overzealous treatment "is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death," the pope wrote.

Pope Francis acknowledged that the factors at play in decisions to forego or withdraw treatment are "often difficult to evaluate." However, he said, it is not appropriate to mechanically apply a general rule to determine whether a treatment is overzealous in any given case. Much depends on the patient's individual circumstances.

The pontiff said a patient who is competent and able must have the primary role in this discernment "in dialogue with medical professionals."

He acknowledged that the informed evaluation of the proportionality of treatment options is not easy, especially given the fragmented nature of the medical delivery system and patient's relationship with multiple providers. He urged medical professionals and loved ones to accompany the dying and practice "responsible closeness," showing love and solidarity during a final illness.

The pope praised the work of palliative care staff. "Even if we know that we cannot always guarantee healing or a cure, we can and must always care for the living, without ourselves shortening their life, but also without futilely resisting their death. This approach is reflected in palliative care, which is proving most important in our culture, as it opposes what makes death most terrifying and unwelcome — pain and loneliness," the pope wrote.

Democratic societies must address the issue of futile care of the dying "calmly, seriously and thoughtfully," the pope said. Dialogue on the subject must take into account the diversity of worldviews, ethical convictions and religious perspectives. The interests of the most vulnerable must be protected and the common good must prevail, he said.

Pope Francis decried the "growing inequality of health care," in which "privileged segments of the population" get access to sophisticated and costly treatments that may not be available either to the poor, even in wealthy countries; or to patients in the developing world. He said in wealthy countries there is a growing risk that access to health care will be "more dependent on individuals' economic resources than actual need for treatment."

Fr. Charles E. Bouchard, OP, is CHA senior director of theology and ethics. He said that in the letter, "Pope Francis drew attention to what Catholics long referred to as 'the happy death' — one that is accepted with peace and hope. His admonition about exercising prudent judgment about end-of-life care decisions not only helps reduce inappropriate care, but reminds us that death is a spiritual as well as a clinical reality."

Fr. Bouchard said, "I think the most important part of Pope Francis' message is the fact that he draws attention to the inequitable distribution of health care globally and even in our own country.

"Careful reflection on what is appropriate care at the end of our lives will help us use limited resources responsibly and experience death as part of our journey in Christ," Fr. Bouchard said.